Laboratory Findings: Measurement of serum tumor markers, beta subunit human chorionic gonadotropin, alphafetoprotein, and lactate dehydrogenase is indispensable in the management of mediastinal germ cell tumors. Patients with benign teratoma, by definition, are marker negative and significant elevations of HCG or AFP implies a malignant component to the tumor. Primary mediastinal seminoma can be associated with low level elevation of HCG (usually less than 100 mlU/ ml), but significant elevation of AFP is diagnostic of a nonseminomatous component of the malignant tumor. In mediastinal nonseminomatous germ cell tumors, the most common tumor marker is AFP with approximately 80 percent having elevated AFP Only 30 percent of patients have elevated HCG. In contrast, elevation of HCG or AFP occurs with near equal frequency in patients with testicular germ cell tumors and are present in 50 to 70 percent of patients and overall, 85 percent of patients with metastatic testicular cancer will have elevations of AFP, HCG, or both. antibiotic levaquin
Clinical Staging: Patients in whom a mediastinal germ cell tumor is suspected should undergo a roent-genographic assessment to determine the extent of disease. In addition to the chest roentgenogram, chest computerized tomography can define encroachment on adjacent structures and assist in subsequent surgical interventions. Abdominal computerized tomography can be useful in determining the presence of liver metastases or, less commonly, unsuspected retroperitoneal disease.
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